Sometimes—but often, not during an active episode. Awareness of illness in psychosis is called insight, and it varies widely from person to person, and even day to day.

When Insight Is Low or Absent

During acute psychosis—such as when someone is experiencing strong delusions or hallucinations—they typically believe their false perceptions are real. For example, if someone hears a voice saying they’re being watched, they may genuinely feel in danger. In that moment, they don’t see it as a symptom; they see it as truth.

This lack of insight (called anosognosia) is part of the illness, not denial or stubbornness. It stems from how psychosis affects brain regions involved in self-awareness.

When Awareness Returns

As treatment takes effect—through medication, therapy, and time—many people regain insight. They may reflect: “Those voices weren’t real,” or “I was unwell, and now I see it.” This shift is often the turning point toward recovery and consistent treatment.

Some people develop partial insight: they accept they have a mental health condition but may still believe certain delusions hold some truth.

Why Insight Matters

Good insight helps with:

• Staying on medication
• Recognizing early warning signs of relapse
• Engaging in therapy

But pushing someone to “admit they’re sick” during active psychosis usually backfires. Instead, focus on building trust and reducing distress. Over time, insight often follows.

Supporting Someone Without Judgment

If a loved one denies their psychosis, avoid arguing. Say, “I see this feels real to you—and I’m here to help you feel safe,” rather than, “That’s not real.” Compassion opens the door to care more than confrontation ever will.

Psychosis doesn’t erase a person’s intelligence or worth—it temporarily distorts their reality. With patience and treatment, clarity can return. And with it, the chance to rebuild.